Wendy Levinson, Marjon Kallewaard, R. Sacha Bhatia, Daniel Wolfson, Sam Shortt, and Eve A. Kerr
W. Levinson, M. Kallewaard, R. S. Bhatia et al., “‘Choosing Wisely': A Growing International Campaign,” BMJ Quality and Safety, Feb. 2015 24(2):167–74.
In addition to wasting valuable resources, the unnecessary use of medical tests, treatments, and procedures can sometimes harm patients. To combat a widespread problem, the American Board of Internal Medicine launched the “Choosing Wisely” campaign in 2012 to encourage physicians and patients to work together to make better health care choices. Based on the program’s early success, other countries are developing their own versions. Health care leaders from 12 countries met in June 2014 to learn from each other’s efforts.
Several factors contribute to the culture of medical overuse, including patients’ expectations, providers’ fears of missing a possible diagnosis, malpractice concerns, and reimbursement incentives. Accordingly, participants agreed that transforming the culture of health care is a central goal.
In the United States, Choosing Wisely has focused on the value of care and the potential risks to patients, rather than costs. Research shows that the terms “right care” and “avoiding harm” resonate for patients, unlike “sustainability” and “use of finite resources.” To combat overuse, more than 60 U.S. medical societies have created lists of common tests, treatments, or procedures that provide dubious value and possibly cause harm—for example, imaging tests for patients with lower back pain when no red flags are present. (Read the Commonwealth Fund–supported article to learn about the early experiences with the campaign in Australia, Canada, Denmark, England, Germany, Italy, Japan, the Netherlands, New Zealand, Switzerland, and Wales.)
The keys to a successful effort to reduce overuse of medical care include: getting the message right; focusing on commonly ordered tests, treatments, and procedures that can be feasibly reduced; support for implementation at the point of care; and introducing the campaign’s lessons into medical education.